| NPI | 1831194190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD 14288) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G36908) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2020-06-27 |